Impressing your attendings during third yr

[ckent]

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Any tips? I don't think that I am succeding in this department, I don't think any of the attendings or residents that I have worked with have been particularly impressed with my work so far. Part of the problem is that I am an awful verbal learner, people say things to me and it goes in one ear and out the other. I usually need to hear things many times before I get it; I never learned material well in lectures during 1st 2 yrs, I always had to go home and read it before I understood it. Some of my classmates seem better at the whole schmoozing and joking around with attendings as well. I am currently doing a rotation in pediatrics, and it would be great if I could read up on what my patients had but we don't know what both of my patients on the floor have so I've been trying to do as much reading as I can but I never seem to hit the stuff that I am being asked on. And finally, my resident gets annoyed when I ask him questions which is really annoying because this is my first rotation and I don't know how else I am supposed to figure out how things work in a hospital. At this point, I would be very happy just to get a "B" and move on to a new rotation so that I can start over. Anyone have any advice for how to do well in peds or in rotations in general?

 

[edmadison]

I'm new at this too, but I can give you some suggestions. Hopefully others will contribute as well.

1) Know everything about your patients -- everything. If the attending asks what his or her shoe size is you should know it (ok I'm exaggerating a bit!). Have all of your patient's labs since admission if hospital stay isn't to great. That way if your attending asks what the alk phos was six days ago, you will know.

2) Volunteer to do things that come up. If a patient on your team has a funky lab finding, volunteer to look it up. That way the next day you can make a quick presentation. A good hand out will go a long way.

3) Know how your attending likes presentations. Fit yours to his or her model. Attendings hate having their time wasted. Make your presentations well thought out and concise.

Anyone have some to add?

Ed

 

[kenfused]

Definitely know your patients well!
Also, practice your morning rounds presentations (esp. for new patients) with your intern or resident the night before (on call). A quick run through with your intern can make a HUGE difference in a good presentation for the morning!!

 

[Hornet871]

The #1 advice I have for you is learn how to kiss butt. If the attending likes fishing, talk about fishing. I'm serious. Time and again, the students who kiss a*s get the grades.

DISCLAIMER: Before anyone flips out, I'm not saying that you can get away with killing all of your patients or being late or consistently screwing up in rounds and on presentations as long as you kiss a*s. Duh, you've got to be at least competent. I'm just saying that all else being close to equal - and even if you're somewhat worse than other students - you can do markedly better if you kiss butt the right way.

"But everyone hates a buttkisser." Not when they don't know you're doing it. Have you ever said, "Nice tie," to someone and have them respond with: "What are you talking about? This tie is HEINOUS!" No. The reply is either a quick "thanks" with no further thought, or, if the wearer is a surgeon, a soliloquoy on the finer points of sartorial sharpness.

It helps to be a (pretty) female student with a male attending. Trust me. I'm generalizing because it's true. When a resident/attending does a procedure, a girl can always say, "Wow, that was great the way you did that LP!" in a my-what-big-muscles-you-have voice, and the male resident/attending will grin, swagger his head, and mutter something self-important about "keeping a cool head".

If, however, you're a guy and you try to butter up a male doctor with a my-what-muscles-you-have line, he'll look at you askance.



Been there, done that.
The Boys of David Green

 

[neutropeniaboy]

Personally, I don't think much of this is very helpful, with the exception of always volunteering to do things that are of clinical relevance; always volunteer for the job (exception -- see thread regarding scut work).

Obviously know your patients. You already know to know this.

As far as kissing ass goes, don't be that guy. Your residents and attendings are smarter than you, and they pick up on this fairly easily. Most of them dislike ass kissers. There are one or two exceptions out there, and they demand that you kiss their **** streaks. In those few cases, pucker up.

The best way to impress your attendings compromises your studying for the rotation in general; you'll have to find a way around this. In surgery and OB/GYN, make sure you know who is on for surgical procedures/c-sections the next day. Find out what they're having and read about the types of procedures. Know the procedures. Nobody gives a **** if you know what type of clamp the surgeon is using. But know why they're doing it and know what they are doing.

For medicine and peds, know the diseases your patients have and read some recent articles about their conditions. When certain lab values come up funky, try to think about what your residents and attendings are going to want to do about it and try to think about why it's low. Anticipation.

I have to admit it -- I'm like you: in one ear and out the other. I spent four years with my nose in a book when not in class or on the floors. That's how I got it down.

Above all, wear comfortable shoes and have a powerbar in your pocket; be prepared to get there early and leave late. Don't be the guy who asks if he can go to the library to study. Get there when they say get there and don't bring up leaving until they say get out of there, unless you have a lecture.

 

[FutureM.D.]

So they like pretty girls?

 

[Winged Scapula]

By far, the best attribute of medical students is their eagerness to learn - medicine in general. Contrary to popular opinion, we don't expect everyone to like surgery or plan it as their career, nor do we like those that do any better than those planning other fields.

However, I am still suprised at the number of medical students who conspicuously roll their eyes when asked to do something, who don't offer to help (ie, when changing dressings in the am, putting charts away after rounds, etc.) or who cannot be bothered to at least act interested in the process of learning.

The students that get the most respect, are the best liked and get the best LORs, are those that make themselves part of the team (which means volunteering for any chore that needs to be done, being friendly and interactive), anticipate our needs (ie, start to take dressings down on patients or at least ask if it needs to be done, have charts available, etc.) and don't audibly groan when rounds go longer than we anticipated or are interrupted with consults, etc. Believe it or not, we (residents and faculty) are just as interested in getting home as you are.

 

[surg]

Finally got my screen name back!

As someone who has done a lot of grading, I want to echo Kimberli's comments.

The number one way to be on my bad list is to consistently look like you have no desire to be on my service. Even if you don't want to be a _fill in the blank with the rotation specialty_, there are plenty of things that you can learn about it that will help you in the future as a good doctor. Even if you can't muster enthusiasm, at least don't make the rest of the team miserable too.

That means:
Be on time. Being late consistently inconveniences your team and your fellow students as they struggle to cover for you.

Be prepared. Know your patients. You should know everything there is to know about what has happened. We don't expect you to come up with a genius diagnosis of some rare disease, but I do expect that you can come up with why they are in the hospital (actually had a student that didn't know why a baby was in the NICU despite writing notes on them 4 days in a row!), what the planned course of action is, and the basic rationale. It also means being ready to help. For example, if it is your patient and you know we take the dressing down on rounds every day, look around and see if there are dressing supplies in the room and send someone for them if they aren't there while someone is taking down the dressing.

Ask intelligent questions at appropriate times. That means not holding up work rounds or interrupting surgery or in front of patients to quibble about points that you think make you look smart but don't contribute to the patient's care or even worse reveal your lack of preparation. Ask those questions later when you are sitting around, e.g. eating breakfast with the intern, or during lulls in the case (NOT while your resident is madly trying to sew up a hole in the vena cava!). In some specialties leisurely discussion at any time may be appreciated, but in surgery, wasting time or interfering with work is something akin to a mortal sin.

Don't get caught brownnosing or backstabbing. I probably don't catch everyone that tries it, and who knows, maybe it works when I don't notice the difference between someone brownnosing and someone who is truly interested, but those that get caught, well... let's just say, everyone has someone that they loved to hate in medical school and you are going to remind them of that person.

That just about wraps it up for now. I know that some of this sounds harsh, but I think every resident (at least in surgery) would agree with me that these are very high on their pet peeves.

 

[Mindy]

Here was my formula:

(Keep in mind I am going to be a pathologist, and made no claim otherwise during my third year!)

1) try to sincerely be interested in whatever rotation I was on. I would often pick areas that did interest me, such as virtually anything that had to do with surgical pathology, and incorporate them into my learning experience on that rotation.

2) try to interact in a sociable, collegiate manner with my attendings and residents, rather than in a nervous-nellie, bored, anxious-to-get-away manner many other students portrayed.

3) try to do whatever it took to make life easier on my residents/interns. I always assumed my role as a third year student was to help get the work done on my service. I also avoided asking any question that I could easily look up, particularly if we were in a hurry. Do not make your residents look bad.

4) I took full responsibility (at least in my own mind ) for whatever patients I had. I would feel guilty if something happened with them and I had to hear about it through the grapevine.

5) Take care of your fellow students. Help students that may be struggling with something (out of sight from residents/attendings of course.) I bought everyone on my team bagels one morning (our residents always bought us pizzas on one of my medicine rotations) and told everyone they were from my med student partner and I. We all felt like a team.

6) Realize you will probably not get all honors.

7) Answer any pimp question directed at you with confidence and without hesitation. You know more than you realize and your answer is probably right. If it isn't right, the time to make mistakes is as a student, so don't worry too much if you don't know it. Some attendings feed off of the nervous energy of their students. Don't be nervous in appearance!

Well that's all I can think of for now.

Mindy

 

[Hornet871]

Most of the advice written here is a bunch of crap. Common sense, hello? Duh: show up on time, don't complain, be courteous and helpful, pretend like you're interested in changing Mr. Smith's necrotic leg ulcer dressing for the 4th time that afternoon even though it stinks up the room worse than your girlfriend's c*nt when she has an untreated yeast infection. Everyone knows that ****.

(I have a hard time believing that students actually roll their eyes when asked to do work. "You'd be surprised." Everyone knows to fake it. No one groans when rounds linger. Maybe I just go to a med school with good actors and hard-workers.)

The difference, my friend, lies in the art of kissing ass. It is an art and yet a science, and those who master it advance furthest.

Sure, some of these residents will tell you that they can spot an ass-kisser a mile away, and, admittedly, the bad ones are obvious and stinky, just like the unmentionables mentioned above. However, the good ones get away with it.

"This nobody can deny, this nobody can deny!"

 

[Winged Scapula]

Originally posted by Hornet871
(I have a hard time believing that students actually roll their eyes when asked to do work. "You'd be surprised." Everyone knows to fake it. No one groans when rounds linger. Maybe I just go to a med school with good actors and hard-workers.)

Believe what you want. I have no incentive in making this up - I HAVE seen it, and have called the student on it, and when it continued, noted it on her evaluation. Others have different forms of protest - audible groans or sighs when rounds take too long, continually asking when we're going home, etc.

Common sense? Perhaps for you and I. But in many people's minds, being on time includes 5 minutes after the appointed meeting hour, or not showing up early enough to complete pre-rounds. IMHO, that is NOT on time, but rather late or at the very least, poor planning. Acting interested apparently is harder for some students here than at your school. Either that, or we're just more boring than the surgery residents at your hive.

BTW, just a little reminder that while you didn't indulge in any foul language, your comparison of the smell of a necrotic ulcer to female genitalia is highly offensive and can be grounds for dismissal from the forum. Please keep the offensive analogies in check.

 

[Acro Yali]

Thanks for the input and I have a situation where I think input from evaluators could be helpful.

There is a student on my service who is a complete @#$^#@% to other people (but not to the residents/attendings). Giving people attitudes after people helped her out, a$$ kissing beyond your wildest imagination, freaking out when some other people took three slices of pizza instead of two during lecture, never admitting her mistakes while jumping on other people's mistakes, complaining/moaning about everything that is wrong in the group (she IS the one who is wrong in the group) and not addressing it within the group but instead b!tches outside to everyone she would meet...etc. We have called for group meetings addressing this very issue but she just doesn't get the fact that we are so sick of her that she shoud just shut her mouth up. Any idea how to deal with this kind of person?

 

[doepug]

Originally posted by Acro Yali
There is a student on my service who is a complete @#$^#@% to other people (but not to the residents/attendings)....Any idea how to deal with this kind of person?

She's on your team, so do your best to be civil.

Otherwise, stop worrying about her. Don't concern yourself with how she acts or what she does.

In the big scheme of things, she doesn't matter.

Life is too short to deal with situations like these. Smile, and do your best to enjoy your rotation.

 

[Whisker Barrel Cortex]

Acro Yali,

We had a student just like that in my group on my OB/GYN rotation. We were all annoyed with him. One of the other students got into a very LOUD argument with him in front of the OB/GYN clinic. Not a good idea since some residents and an attending were within earshot. We started out just talking to him about our concerns but they didn't help. Then we just started ignoring him, which is what I recommend in your situation. Even though she may continue her behavior, residents and attendings can usually pick up on the fact that a student is unpopular with the rest of the group and assume there is a reason for it.

Its only one rotation after all. Next month, hopefully, you'll have a better group.

 

[Acro Yali]

If it were only one rotation, then I wouldn't even let her obnoxious behaviors bother me. The problem is, I and other people in the group will have to tolerate her for an entire year-thats how our rotations are set up. Its going to be a long year.